Asthma Flashcards
Describe the pathohysiology of asthma. 6
Airways almost continuously sensitive or inflamed. Trigger causes bronchospasm. Inflammation increases and mucous secreted. Bronchial muscles. Hyperinflation. Reduction in tidal volume.
What are the 8 triggers that may exacerbate asthma
Pollen. Cigarette smoke. Dust mites. Pets. Mould. Exercise. Stress. Sudden temp changes
What are the 5 clinical features of moderate asthma?
Can speak in full sentences. Spo2 >=92. Peak flow >=50% best or predicated. HR less than or equal to 140 ages 2-5. HR less than or equal to 130 in 5+. RR less than or equal to 40 in 2-5 yrs. less than or equal to 30 in 5+
What are the 5 clinical features of acute severe asthma attack
Can’t complete sentences in one breath or too breathless to talk or feed. SPO2 >140 ages 2-5 >125 ages 5+. RR >40 ages 2-5. HR >30 age 5+.
List the 8 clinical signs of life threatening asthma attack
Cyanosis. Confusion. Silent chest. Hypotension. Exhaustion. Spo2 below 92. PEFR below 33% of best or predicted. Poor resp effort.
How many inhalers used in a year is a red flag?
Over 12
List 5 risk factors of near fatal asthma (medical)
Previous near fatal asthma. Previous hosp admission from asthma especially in last year requiring 3 or more classes of asthma meds. Heavy use of beta2 agonist. Repeated ED attendance for asthma care especially in last year. Brittle asthma.
List 15 physiological/behavioural risk factors for near fatal asthma
Non compliance with treatment/monitoring. Failure to attend appointments. Fewer GP contacts. Frequent home visits. Self discharge from hosp. Psychiatric illness or self harm. Current or recent major tranquilliser use. Denial. Alcohol or drug abuse. Obesity. Learning difficulties. Employment problems. Social isolation. Childhood abuse. Severe domestic marital or legal stress
How would you manage moderate asthma attack? 4
Move to calm quiet environment. Encourage use of own inhaler 2 puffs every 2 minutes up to a max of 10. High%o2 therapy. Consider nebuliser salb.
How would you manage acute/severe asthma attack. 2
Consider ipatropium bromide nebuliser. Continue with salb neb unless clinically significant side effects occur.
How would you manage life threatening asthma 1
Consider administering adrenaline
How would you manage near fatal asthma 1
Consider positive pressure ventilations using BVM and T peice
What four obs must you remember before and after asthma treatment?
HR. RR. PEFR. Etco2 and spo2
What are the therapeutic effects of using salbutamol.
Reverses bronchospasm and is a selective beta2 adrenoreceptor stimulant
What are the indications for salb use 4
Acute asthma attack. Expiratory wheeze. Exacerbation of COPD. SOB due to LVF
What are the contraindications of salb use?
None
What are the cautions for using salb? 5
HTN+. Angina. Overactive thyroid. late pregnancy. Beta-blockers.
What are the five side-effects for using salbutamol
Tremor. Tachycardia. Palpitations. Headache. Feeling of tension. Peripheral vasodilation
What is the Administration and dosage for six years plus using salbutamol
5 mg nebulised
What is the administration and dosage for ages less than or equal to 5 years
2.5 mg nebulised. Always cross check pocketbook the dosage and routes
What are the therapeutic effects for using Ipatropium bromide
Antimuscarinic bronchodilator
What are the three indications for use of Atrovent
Acute severe or life-threatening asthma. Acute asthma unresponsive to salbutamol. Exacerbation of COPD unresponsive to salbutamol
What are the contra indications for using Atrovent
None
What are the three cautions for using Atrovent
Glaucoma. Pregnancy and breastfeeding. Prostatic hyperplasia
What are the seven side-effects for using Atrovent
Headache. Nausea and vomiting. Dry mouth. Difficulty in passing urine and or constipation. Tachycardia/arrhythmia. Paroxysmal tightness of chest. Allergic reaction
What is the administration and dosage for using Ipratropium bromide. 3
Adult >12 500mcg. 18months -
How many nebulisations can you give Atrovent
Once only
After how many doses of salbutamol would you administer I Pratropium bromide
Concurrent with first dose of salbutamol in severe or life-threatening asthma. Or concurrent with second or later dose of salbutamol and unresponsive COPD or asthma
When would you do a time critical transfer for asthma
In life-threatening or acute severe asthma
What are the two therapeutic effects of adrenaline 1:1000
Sympathomimetic that stimulates both alpha and beta receptors. Release bronchospasm in acute severe asthma
What is the indication for using adrenaline 1:1000
Life-threatening asthma with failing ventilation and continue deterioration despite nebulisation therapy
What is a contra indication of using adrenaline
Repeated doses in hypothermic patients
What are the cautions of using adrenaline2
Beta-blockers. Tricyclic antidepressants
What are the side effects of using adrenaline
None
What is the administration and dosage of adrenaline 1 in 1000. 4
Adult 500mcg IM. Child 6-11 300mcg. 0-5 years 150mcg. Repeat after 5mins if clinically indicated. Always cross check pocket book for dosesge and routes
State the 6 aietiologys of asthma
Inherited. Modern lifestyles. Smoking during pregnancy. Environmental pollution. Viral infections. Irritants found in workplace
